Your Name*

Contact Number*

Email*

Who are you nominating?* Please select... Individual Club Myself

Club Name*

Club Contact Name*

Club Contact Number*

Club Contact Email*

Nominee's Name*

Nominee's Contact Number*

Nominee's Email Address

Please select which award you are nominating for:*

Reason for nomination, providing evidence and addressing key criteria * Please provide a summary detailing your reason for nomination and attach any supporting evidence below:* Max 255 characters

REQUIRED: Supporting documentation 1 if available please include written references, records of results and achievements, or any imagery of your nomination.*

OPTIONAL: Supporting documentation 2 if available please include written references, records of results and achievements, or any imagery of your nomination.

OPTIONAL: Supporting documentation 3 if available please include written references, records of results and achievements, or any imagery of your nomination.

Have you read the Selection and Nomination Criteria?*

Has your nominee won an award at the Uni Blues Awards Night before?* Please select... Yes No Unsure

If yes, what year?